Hygiene in healthcare - cleaning in the spotlight

18th of March 2014

Outbreaks of Hospital Acquired Infections (HAIs) have made the news across Europe, bringing the issue of hygiene into the spotlight. ECJ asks cleaning service providers what their main challenges are when working in hospitals, and how their processes have altered in recent years in line with better knowledge and higher standards.

Healthcare hygiene has been a hot topic in the news in recent years, as outbreaks of various Hospital Acquired Infections (HAIs) have taken hold in hospitals across Europe. This has very much brought the issues surrounding cleanliness and hygiene under the spotlight, and cleaning service providers have come under increased scrutiny. ECJ spoke to a number of the leading companies providing cleaning services to Europe’s hospitals about the greatest challenges they are facing at the present time.

Janine de Vries, product manager healthcare at Gom ZorgSupport – which specialises in cleaning and related facility services in health care institutions in the Netherlands – explained its main objective is to meet the needs of its customers. “We notice the importance of cleaning in healthcare is increasing and budgets at the same time are decreasing,” he said.

“This means we have to ensure every day all our staff are strictly following all protocols related to infection control. At the same time we must ensure our cleaners increasingly become service hosts who have an important role in giving the patients a good experience. This requires a cultural change but also smarter solutions, because we have to meet all these requirements and at the same time we must lower our costs.”

“Infection prevention and control is being more and more highly scrutinised than ever before, and we expect this trend to continue as healthcare providers seek to offer the best levels of patient care,” commented Lauren Kyle, cleaning development manager at Sodexo. “The biggest challenge for facilities management partners providing cleaning services is that in this crucial aspect of patient care, each client site will have slightly different procedures for infection prevention and control.”

Kyle continued: “As service providers operating across multiple sites this challenge is an opportunity to work closely with each individual client to understand exactly how we can fit into their existing policies and procedures.”

From the OCS Group’s point of view there have been no new major challenges in terms of dealing with HAI outbreaks in recent years. Healthcare director Petra Moss explained: “Through our experience as providers of specialist healthcare cleaning services to a number of healthcare providers across the country, our teams have been highly trained and gained in-depth knowledge of how to deal with HAIs, their associated risks and their specific behaviours, such as the seasonal peaks of the Norovirus from November through to February.”

Outbreak prevention

Gom ZorgSupport’s quality manager Peter Hartog talked about some of the other key challenges being faced by cleaning companies with particular regard to infection prevention.

• The collaboration between cleaning companies and other parties in the hospital like hygienists and nurses. To prevent outbreaks of HAIs an integral approach is needed. Because there are many parties involved, it can be difficult to streamline communication, working processes and responsibilities

• The working processes and protocols in nursing homes. The infection prevention policy in many nursing homes is not as professional as in hospitals. For example there is a lack of certain protocols. This is a challenge for cleaning companies, but also an opportunity, because they can offer added value by offering expertise

• Lack of clarity about who is responsible for the cleaning of elements like wheelchairs or infusion poles

• The importance of adapting the level of cleaning to the level of infection risk. The level of infection risk, however, can change from patient to patient and from moment and moment. This makes it hard to standardise cleaning processes.

Ensure compliance

So, as knowledge about risk areas has improved in recent years and the requirement for higher cleaning standards has intensified, have the procedures undertaken by service providers when working in hospitals altered significantly? Sodexo’s Lauren Kyle explained: “Cleaning service providers must work closely with hospitals to ensure compliance as contractually obliged depending on the year specified. For example in the UK, NHS trusts are governed by National Standards, which have steadily increased in scope and scrutiny since 2004.”

She continued: “As you go into patient areas now there are a lot more materials for infection control, such as bacterial soaps and wipes. On a monthly basis nursing staff are carrying out audits and feeding back to senior nurses.”

“Our cleaning services are no longer only tailored to the general requirements hospitals have, instead we have divided the hospital into different areas and adapted our cleaning services to the requirements of the specific area,” explained Janine de Vries at Gom. “Because of this we are able to have a stronger focus on infection prevention in high risk areas like intensive care units and surgery rooms, while also concentrating on hospitality in public areas.

“As a consequence our approach of scheduling the staff has been changed too. Our cleaners in surgery rooms now have a different profile than our cleaners in nursing areas for example.”She continued: “Disinfection policies in hospitals have also altered. We are more aware of the negative effects of chlorine, therefore we disinfect only when it is really necessary. Besides that we are looking for an appropriate alternative to chlorine.

“We have also noticed that transparency has become increasingly important in that hospitals must now be able to prove the cleaning process is well organised. So cleaning companies keep better records of their working processes and quality measurements are constantly evolving.”

These evolutions in the service provision inevitably mean changes in cleaning staff training requirements, as Lauren Kyle explained. “All cleaning staff are trained in infection prevention and control, working with cleaning managers and the hospital infection control training team, with a refresher every six months. All our staff carry an infection control passport book, which expires after a year to identify when they need to take an infection control exam to renew their passport.

“This forms part of a structured and comprehensive training programme, which is a key component of Sodexo’s cleaning offers for healthcare environments. There’s increased focus for cleaning service providers on touch points, for example, which means that as well as cleaning the whole area, more frequent cleaning is necessary on places like door handles and patient dining surfaces - places from where infection is more likely to spread.”

“We certainly now offer more education to our hospital cleaners now, and a greater level of specialised training,” said Peter Hartog. “For example cleaning in cleanrooms. Also our training and management style has developed from instructing and telling our staff how to work to coaching and explaining to our staff why they work in a certain way.”

Manufacturers of cleaning solutions too are playing a significant role in improving working methods and the final result. “There is continual work in upgrading the effectiveness of microfibre cloths and flat mopping systems already in use,” said Kyle. “UVC technology is also being used increasingly in healthcare environments as an addition to the cleaning regime.”

New product solutions

“The introduction of microfibre resulted in major improvements in cleaning,” agrees de Vries. “Although this is an innovation that has already been in use for a long time now, it is still worth mentioning because it helps cleaning companies to prevent cross-contamination.

“Another key development is that cleaning products are become more and more ergonomic, easier to clean and easier to use. As a result the continuity and productivity of our staff has increased. The telescope pole, the two-sided mop and the smaller and more mobile scrubbing machines are good examples of that.”

Hartog continued: “We also see new floor maintenance solutions which makes it possible to integrate periodic floor maintenance into daily floor maintenance. Another interesting trend is that companies from outside the cleaning industry are introducing innovative solutions. In collaboration with an IT company, for example, we at Gom ZorgSupport are developing a scheduling and communication tool which helps us to adapt our cleaning activities to patient occupation levels and specific needs.”

To keep abreast of the latest risks and up-to-date knowledge about hygiene matters in healthcare then, service providers must collaborate more and more closely with each hospital’s infection control personnel. Peter Hartog explained: “Four times a year we meet with the hygienists at the hospitals. During this meeting we talk about developments and bottlenecks related to infection control and discuss how we can respond to this so we can improve our services.”

Janine de Vries added: “Furthermore we contact hospital infection control personnel immediately in cases when we see infection risks. Vice versa the hospital infection control personnel contact us when infection outbreaks happen, in case procedures have changed or they have any specific advice about how we can prevent infection more effectively. And our quality officer is responsible for following infection control trends by visiting exhibitions and keeping in touch with experts in the field.”

“Cleaning service managers have to work closely with infection control personnel as we are governed by their policies and procedures, which include training of our staff,” said Lauren Kyle.

The crucial role now being played by cleaning service providers in all hospitals was summarised by OCS’s Petra Moss. “An experienced cleaning contractor plays an intrinsic part in keeping a hospital scrupulously clean, working hand-in-glove with HAI teams to give continual support and advice on compliance, efficiency of procedures, innovation, and value for money in order to deliver an optimum service. We also advise on policies and training in other areas which are key to infection control such as hand hygiene.

“Our teams have tried and tested products and methods to achieve the most effective and best value service. Our clients rely on us to identify and alert them to any new products or methods which could potentially add value to the cleaning and infection control offering.”